AHM-520 Free Practice Test

- (Topic 1)
The Eagle health plan wants to limit the possibility that it will be held vicariously liable for the negligent acts of providers. Dr. Michael Chan is a member of an independent practice association (IPA) that has contracted with Eagle. One step that Eagle could take in order to limit its exposure under the theory of vicarious liability is to

1. A. Supply D
2. B. Chan with office space
3. C. Employ nurses, laboratory technicians, and therapists to support Dr.Chan
4. D. Be responsible for keeping D
5. E. Chan's medical records updated
6. F. Ensure that documents provided to D
7. G. Chan's patients describe him as an independent practitioner

Correct Answer: D

- (Topic 2)
The amount of risk for health plan products is dependent on the degree of influence and the relationships that the health plan maintains with its providers. Consider the following types of managed care structures:
✑ Preferred provider organization (PPO)
✑ Group model HMO
✑ Staff model health maintenance organization (HMO)
✑ Traditional health insurance
Of these health plan products, the one that would most likely expose a health plan to the highest risk is the:

1. A. preferred provider organization (PPO)
2. B. group model HMO
3. C. staff model health maintenance organization (HMO)
4. D. traditional health insurance

Correct Answer: C

- (Topic 2)
Costs that can be defined by behavior are most commonly classified as fixed costs, variable costs and semi-variable costs. Examples of fixed costs include:

1. A. Rent, insurance expense, and depreciation on computer equipment
2. B. Rent, claims processing costs, and selling expenses
3. C. Claims processing costs, telephone expense, and depreciation on computer equipment
4. D. Premium processing, rent, and selling expenses

Correct Answer: A

- (Topic 2)
The Arista Health Plan is evaluating the following four groups that have applied for group
healthcare coverage:
✑ The Blaise Company, a large private employer
✑ The Colton County Department of Human Services (DHS)
✑ A multiple-employer group comprised of four companies
✑ The Professional Society of Daycare Providers
With respect to the relative degree of risk to Arista represented by these four companies, the company that would most likely expose Arista to the lowest risk is the:

1. A. Blaise Company
2. B. Colton County DHS
3. C. Multiple-employer group
4. D. Professional Society of Daycare Providers

Correct Answer: A

- (Topic 2)
The Longview Hospital contracted with the Carlyle Health Plan to provide inpatient services to Carlyle’s enrolled members. Carlyle provides Longview with a type of stop-loss coverage that protects, on a claims incurred and paid basis, against losses arising from significantly higher than anticipated utilization rates among Carlyle’s covered population. The stop-loss coverage specifies an attachment point of 130% of Longview’s projected $2,000,000 costs of treating Carlyle plan members and requires Longview to pay 15% of any costs above the attachment point. In a given plan year, Longview incurred covered costs totaling $3,000,000.
Carlyle most likely is responsible for paying Longview for the claims incurred before Longview has actually paid the medical expenses.

1. A. True
2. B. False

Correct Answer: B